Grant Abstract: DASH-Sodium Trial in Adolescents

Grant Number: 5U01HL128834-02
PI Name: Weaver
Project Title: DASH-Sodium Trial in Adolescents

Abstract: In the United States, children 4-18 years have the highest risk of nutrient inadequacy, even with the use of dietary supplements. Nutrient inadequacy during this period is particularly important since bone development and growth are hallmarks of this life stage, and since optimal bone health in adulthood depends heavily upon bone accretion and maintenance that occurs during childhood and adolescence. More than 53 million adult Americans have low bone mass or osteoporosis, hereto in referred to as bone disorders. Bone disorders are substantially more prevalent in non-Hispanic Whites when compared to Hispanic and Mexican Americans, non-Hispanic Black, and non-Hispanic Asians (i.e., racial minorities in the U.S.). Nutrition and physical activity are the primary modifiable factors associated with bone health. Calcium and vitamin D have well-established roles with regard to bone health. Furthermore, emerging evidence suggests that several other dietary factors, such as intakes of fruits and vegetables, B-vitamins, potassium, magnesium, sodium, and their ratios in the diet, are important predictors of bone mineral content/density. Therefore, these dietary factors have the potential to modify risk for bone disorders. However, there is a significant gap in what is known about the antecedents of racial differences in bone health in adolescence, particularly with regard to the impact of diet.

The Dietary Approaches to Stop Hypertension (DASH) diet is rich in many of the dietary components relevant to bone health, and reduces blood pressure in adults, particularly among those with elevated blood pressure and in Blacks. The parent proposal describes an effort to evaluate the effects of the DASH diet on reducing hypertension in adolescents. Specifically, Camp DASH is a 2x2 factorial cross-over clinical feeding trial to examine the DASH diet relative to blood pressure in a raciallydiverse group of adolescents, 11-15 years of age, using a residential summer camp in 4 consecutive years, 2017-2020. The objective of this administrative supplement is to address the significant gap in data regarding bone health in adolescence by leveraging this trial, a unique opportunity to examine dietary factors relative to bone health in an existing, high quality trial (1U01HL117835). While the parent grant can only support collection of bone markers in a limited sample in year 3 (n=75) and prohibiting subgroup analysis by race, sex, and diet intervention, the proposed project will measure and characterize in Specific Aim 1, bone turnover markers (BTM; e.g., bone alkaline phosphatase (BAP), osteocalcin (OC), serum type 1 procollagen N-terminal (P1NP), and N-terminal telopeptide (NTx)), as indicators of bone health, in a racially diverse sample of adolescents (n=150) and will determine in Specific Aim 2, the response, if any, to dietary manipulation.

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